No
| CAH511312-01 | Child | CAH | PRESTON MEMORIAL HOSPITAL | PRESTON MEMORIAL FAMILY CARE- FELLO | 2287 S. MOUNTAINEER HWY | THORNTON | WV | Terminated |
| CAH511312-02 | Child | CAH | PRESTON MEMORIAL HOSPITAL | PRESTON MEMORIAL FAMILY CARE --KING | 150 Memorial Drive | KINGWOOD | WV | Active |
| CAH511312-03 | Child | CAH | PRESTON MEMORIAL HOSPITAL | PRESTON MEMORIAL HOSPITAL URGENT CA | 12302 Veterans Memorial Highway | REEDSVILLE | WV | Active |
| CAH511312-04 | Child | CAH | PRESTON MEMORIAL HOSPITAL | PRESTON MEM HOSP PRIMARY CARE- KING - Primary Care | 428 Morgantown Street | KINGWOOD | WV | Active |
| CAH511312-05 | Child | CAH | PRESTON MEMORIAL HOSPITAL | PRESTON MEMORIAL PRIMARY CARE-MILES - Primary Care | 110 N PRICE ST | KINGWOOD | WV | Active |
| CAH511312-06 | Child | CAH | PRESTON MEMORIAL HOSPITAL | Mon Health Preston Recovery Care Program - Mon Health Preston Recovery Care Program | 428 Morgantown Street | Kingwood | WV | Active |
| Details | Last Recertification Date | Update | Recertification | 8/29/2023 7:16:21 AM | 8/28/2024 8:02:58 AM | 8/28/2024 8:02 AM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2022 10:29:08 AM | 8/29/2023 7:16:21 AM | 8/29/2023 7:16 AM |
| Contacts | Primary Contact | Update | Recertification | WALKER, SHARI
Managing Accountant
Preston Memorial Hospital
3043291400-1610 | Cunningham, Jennifer
Director of Pharmacy
Mon Health Preston Memorial Hospital
3043291400-3600 | 9/8/2022 10:29 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2021 8:08:12 AM | 9/8/2022 10:29:08 AM | 9/8/2022 10:29 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | GESSLER., KEVIN
CHIEF FINANCIAL OFFICER
Preston Memorial Hospital
3043291400-1120 | GESSLER, KEVIN
Vice President Financial Services
Preston Memorial Hospital
3043291400-1120 | 1/18/2022 2:05 PM |
| Contacts | Primary Contact | Update | Profile Change Request | WALKER, SHARI
CONTROLLER
Preston Memorial Hospital
3043291400-1610 | WALKER, SHARI
Managing Accountant
Preston Memorial Hospital
3043291400-1610 | 1/12/2022 11:50 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2020 2:12:49 PM | 9/1/2021 8:08:12 AM | 9/1/2021 8:08 AM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2019 3:53:19 PM | 9/1/2020 2:12:49 PM | 9/1/2020 2:12 PM |
| Details | Last Recertification Date | Update | Recertification | 8/20/2018 2:25:29 PM | 8/28/2019 3:53:19 PM | 8/28/2019 3:53 PM |
| Details | Last Recertification Date | Update | Recertification | 11/28/2017 8:18:45 AM | 8/20/2018 2:25:29 PM | 8/20/2018 2:25 PM |
| Contacts | Primary Contact | Insert | Recertification | | WALKER, SHARI
CONTROLLER
Preston Memorial Hospital
3043291400-1610 | 11/28/2017 8:18 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2016 12:00:00 AM | 11/28/2017 8:18:45 AM | 11/28/2017 8:18 AM |
| Contacts | Authorizing Official | Update | | GESSLER., KEVIN
CHIEF FINANCIAL OFFICER
3043291400-1120 | GESSLER., KEVIN
CHIEF FINANCIAL OFFICER
Preston Memorial Hospital
3043291400-1120 | 11/16/2017 4:36 PM |
| Contacts | Authorizing Official | Insert | | | GESSLER., KEVIN
CHIEF FINANCIAL OFFICER
3043291400-1120 | 4/24/2017 3:55 PM |
| Addresses | Main Address | Insert | | |
12302 Veterans Memorial Highway
Suite 4
REEDSVILLE, WV 26547-7523 | 8/24/2016 12:01 PM |
| Contacts | Signed By | Insert | | | MILVET Jr., ROBERT W.
CHIEF FINANCIAL OFFICER
3043294700 | 8/24/2016 12:01 PM |
| Details | Last Recertification Date | Update | | 8/19/2015 12:00:00 AM | 8/24/2016 12:00:00 AM | 8/24/2016 12:01 PM |
| Addresses | Billing Address | Insert | | | Preston Memorial Hospital
150 Memorial Drive
Kingwood, WV 26537 | 5/5/2016 8:23 AM |
| Details | Last Recertification Date | Update | | | 8/19/2015 12:00:00 AM | 8/19/2015 7:05 PM |
| Dates | Participating Approval Date | Update | | | 9/8/2014 12:00:00 AM | 9/8/2014 10:13 AM |
| Details | State | Update | | Pending | Active | 9/8/2014 10:13 AM |
| Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 9/8/2014 10:13 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_44238 | CAH511312-03 | 9/6/2014 6:10 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_44238 | 7/2/2014 3:26 PM |
| Details | Last Recertification Date | Insert | | | | 7/2/2014 3:26 PM |
| Details | Grant Number | Insert | | | | 7/2/2014 3:26 PM |
| Details | 340B ID | Insert | | | | 7/2/2014 3:26 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/2/2014 3:26 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/2/2014 3:26 PM |
| Details | Medicare Provider Number | Insert | | | 511312 | 7/2/2014 3:26 PM |
| Details | Entity Name | Insert | | | PRESTON MEMORIAL HOSPITAL | 7/2/2014 3:26 PM |
| Details | Program Code | Insert | | | CAH | 7/2/2014 3:26 PM |
| Details | Entity Subname | Insert | | | PRESTON MEMORIAL HOSPITAL URGENT CA | 7/2/2014 3:26 PM |
| Dates | Participating Approval Date | Insert | | | | 7/2/2014 3:26 PM |
| Details | State | Insert | | | Pending | 7/2/2014 3:26 PM |
| Dates | Registration Date | Insert | | | 7/2/2014 12:00:00 AM | 7/2/2014 3:26 PM |
| Dates | Signed By Date | Insert | | | 7/2/2014 12:00:00 AM | 7/2/2014 3:26 PM |
| Dates | Start Date | Insert | | | | 7/2/2014 3:26 PM |
| Terminations | Termination Comments | Insert | | | | 7/2/2014 3:26 PM |
| Terminations | Termination Date | Insert | | | | 7/2/2014 3:26 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/2/2014 3:26 PM |
| Terminations | Termination Reason | Insert | | | | 7/2/2014 3:26 PM |